Information on non-VA services use may be obtained directly from the participant. Below are some points to keep in mind.
Categories of Care
Self-report questions should focus on categories of care for which costs are different and for which patients cognitively keep them separate. For example, it is common to ask about nights of inpatient care and then number of outpatient visits. However, it is probably not a good idea to ask about nights of intensive care unit (ICU) hospitalizations. Patients may recall being in an ICU, but are unlikely to be able to separate these categories accurately.
If the analyst uses the VA utilization databases and uses self-report for non-VA care, it is highly recommended that one set of questions specifically pertain to VA care and a second set of questions pertain to non-VA care. This permits validating the accuracy of self-reporting using patient responses for VA care for the study sample.
In almost every case, patients are not reliable sources of cost information because they rarely see the bill(s); bills can be confusing to say the least and recall of these data is not accurate. Therefore, the analyst must multiply the self-report data on units with estimated unit costs.
Researchers at the Health Economics Resource Center (HERC) have been involved in a number of clinical trials where there is an interest in understanding how the intervention affects veterans' use of care, including veterans' use of non-VA care. HERC researchers have developed a standard set of questions on self-reported non-VA utilization. These questions are often tailored or augmented for a particular study.
It is important to keep in mind that self-report involves cognitively complex questions. The patient is being asked to go back in time to remember events. The accuracy of the recall can be confounded if the events occurred a long time ago or if the patient used a lot of care. There is also inherent tension between asking precise questions and making the questions more cognitively complex to the point where the respondent is confused and the data are less accurate. For example, a visit to the emergency department (ED) where the patient stayed in the hospital overnight is unambiguously an ED visit but it is unclear whether it was also an inpatient stay. Adding qualifiers, such as "admitted to the hospital," may add precision at the risk of reducing accuracy.
Last updated: February 17, 2022